对于 Roux-en-Y 胃旁路术后体重复发的患者，与单纯的胃空肠吻合口修复术相比，胃空肠吻合口修复术联合胆胰支延长术能带来更显著的体重减轻和更好的代谢效果。

Gastrojejunostomy revision combined with biliopancreatic limb lengthening provides superior weight loss and metabolic outcomes compared to gastrojejunostomy revision alone in Roux-en-Y gastric bypass patients with weight recurrence.

作者信息

Amodu Leo I, Johnson Lauren, Wynens Kallie E, Pawar Omkar S, Catanzaro Nicholas, Adnan Sakib, Khaitan Leena, Abbas Mujjahid

机构信息

Division of General Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.

Department of Surgery, Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA.

出版信息

Surg Endosc. 2025 Sep 12. doi: 10.1007/s00464-025-12186-2.

DOI:10.1007/s00464-025-12186-2

PMID:40938366

Abstract

INTRODUCTION

The Roux-en-Y gastric bypass (RNYGB) is an effective bariatric surgical procedure for weight loss. Some patients experience weight recurrence or fail to lose weight after a RNYGB. No consensus exists on a recommended revisional procedure for RNYGB patients with weight recurrence.

METHODS

We carried out a retrospective review of records from 2010 to 2024, examining patients who had a prior RNYGB, requiring revision for weight recurrence. We compared patients who had revision of the gastrojejunal (GJ) anastomosis alone, to patients who had revision of the gastrojejunal anastomosis and lengthening of the biliopancreatic (BP) limb (GJ + BPLL). We compared demographics, weight outcomes, as well as postoperative complications.

RESULTS

Fifty-one RNYGB patients had a revision primarily for weight recurrence. Twenty-three patients had a GJ revision alone, while 28 patients had a GJ + BPLL. At 24 months post-revision, the GJ + BPLL group had a significantly lower median weight (lbs.) (GJ vs. GJ + BPLL; 288 vs. 186, p = 0.003), as well as BMI (GJ vs. GJ + BPLL; 45.1 vs. 31.91, p = 0.024). Post-revision HbA1c levels were also significantly lower in the GJ + BPLL group (GJ vs. GJ + BPLL; 5.4 vs. 5, p = 0.035). The GJ + BPLL group had a higher rate of multiple vitamin deficiencies. There was no difference between the groups beyond 36 months.

CONCLUSION

In patients with weight recidivism after a primary RNYGB, GJ + BPLL can achieve greater reduction in weight and BMI with comparable complication rates compared to GJ revision alone, with a clear advantage in HbA1c reduction. While the weight loss outcomes appear to equalize between groups after 36 months, no patients with GJ + BPLL returned to their pre-revision weight. Larger studies are needed to evaluate differences in durability of GJ + BPLL, as well as other long-term outcomes.

摘要

引言

Roux-en-Y胃旁路术（RNYGB）是一种有效的减肥减重手术。一些患者在接受RNYGB手术后出现体重反弹或减肥失败。对于体重反弹的RNYGB患者，目前尚无推荐的翻修手术的共识。

方法

我们对2010年至2024年的记录进行了回顾性研究，检查了之前接受过RNYGB手术且因体重反弹需要翻修的患者。我们将仅对胃空肠（GJ）吻合口进行翻修的患者与同时进行胃空肠吻合口翻修和延长胆胰（BP）袢（GJ + BPLL）的患者进行了比较。我们比较了人口统计学特征、体重结果以及术后并发症。

结果

51例RNYGB患者主要因体重反弹进行了翻修手术。23例患者仅进行了GJ翻修，而28例患者进行了GJ + BPLL手术。翻修术后24个月，GJ + BPLL组的中位体重（磅）显著更低（GJ组 vs. GJ + BPLL组；288 vs. 186，p = 0.003），体重指数（BMI）也更低（GJ组 vs. GJ + BPLL组；45.1 vs. 31.91，p = 0.024）。翻修术后GJ + BPLL组的糖化血红蛋白（HbA1c）水平也显著更低（GJ组 vs. GJ + BPLL组；5.4 vs. 5，p = 0.035）。GJ + BPLL组多种维生素缺乏的发生率更高。36个月后两组之间没有差异。

结论

对于初次RNYGB术后体重复发的患者，与单纯GJ翻修相比，GJ + BPLL能实现更大程度的体重和BMI降低，并发症发生率相当，在降低HbA1c方面具有明显优势。虽然36个月后两组的减肥效果似乎趋于均衡，但没有接受GJ + BPLL手术的患者恢复到翻修前的体重。需要更大规模的研究来评估GJ + BPLL的持久性差异以及其他长期结果。